No Slide TitleManual Therapy Techniques
manual therapy: the use of hands-on techniques to evaluate, treat, and improve the status of neuromusculo-skeletal conditions
massage: the systematic and scientific manipulation of soft tissue for remedial or restorative purposes
Muscle relaxation
Promotion of fluid mobilization
Effleurage
Friction massage uses small area, constant pressure, crossing pattern.
myofascial release: the use of manual contact for evaluation and treatment of soft-tissue restriction and pain with the eventual goal of the relief of those symptoms to improve motion and function
Continuous structure that surrounds and integrates tissue throughout body
Fascia Anatomy
Superficial
Biomechanical Considerations
Myofascial release a misnomer
Myofascial Release (MFR) Treatment Guidelines
Treatment time: 3-5 min
Apply MFR with your upper extremities relaxed
Can use various stroking techniques
J-stroke
Indications, contraindications, precautions
trigger point: “a focus of hyperirritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness, and sometimes to referred autonomic phenomena and distortion of proprioception” (Travell and Simons 1983)
Taut band of muscle tissue
Myofascial Trigger Points
Focal point—appears as nodule
Pressure on the nodule—can cause referred pain or autonomic response
Active trigger points
Latent trigger points
Trigger Point Characteristics
More irritable trigger point = more severe referred pain
(continued)
Injury
Overload
Fatigue
Acute
The exact mechanism of trigger points is really unknown and is only theory at this time.
Trigger Point Treatment
Trigger point examination
PNF, hot packs, ultrasound, electrical stimulation
Effect of Trigger Point Release Via Ice-Stretch
on Neural Pathways
Adapted from Simons, Travell, and Simons 1999.
Trigger point treatment must be accompanied by stretching of the muscle to be most effective.
Trigger Points
and Stretching
muscle energy technique: a manual technique that involves the voluntary contraction of a muscle in a precisely controlled direction, at varying levels of intensity, against a distinct counterforce applied by the sport rehabilitation specialist. Essentially, it is the use of muscle contraction to correct a joint’s malalignment which occurs when the body becomes unbalanced.
Malalignments occur due to muscle spasm, weakness, restricted mobility etc.
Muscle Energy Theory
Patient controls magnitude.
Muscle contraction allows for improved relaxation and motion.
Patient’s segment is placed at end of barrier.
Muscle Energy Application
Muscle contraction is submaximal isometric contraction (2 oz), 5-10 s.
Patient relaxes; segment is passively moved to the new barrier.
3-5 repetitions are performed.
Repeat as above for isotonic contraction but allow thru full ROM
Muscle Energy Application
Resistance should allow motion at an even and controlled speed.
Refractory period is needed
Patient relaxes; segment is passively moved to the new barrier.
3-5 repetitions are performed.
joint mobilization: passive movement of a joint in either physiological or accessory movements to either relieve pain or improve motion
Physiological vs. accessory motion
Basic Concepts
Concave and convex rules
Capsular patterns of motion
Rules for Concave-
on-convex and Convex-
on-concave Joint Surfaces
Joint mechanoreceptors are stimulated to inhibit pain stimulation and can cause muscle relaxation.
Effects of Joint Mobilization
Distraction and gliding can cause improved synovial fluid movement to improve nutrition to the joint.
Stretch of the capsule can cause plastic deformation of collagen to improve motion.
Grades of movement